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Bloom JL, Wu EY. Update on antineutrophil cytoplasmic autoantibody vasculitis in children. Curr Opin Rheumatol 2024:00002281-990000000-00124. [PMID: 38990100 DOI: 10.1097/bor.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
PURPOSE OF REVIEW Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is often organ- or life-threatening in children and impacts them during important periods of psychosocial and physical development. This review covers recent advances in the pathophysiology, diagnosis, management, and outcomes of AAV in children and highlights the ongoing need for funding and increased research collaboration. RECENT FINDINGS Recent work has improved our understanding of AAV disease pathogenesis, potentially identifying new biomarkers and therapeutic targets. Collaborative clinical studies have also highlighted the variable manifestations in children and identified potential factors associated with poorer outcomes. Consensus-based treatment guidelines are also appearing, but clinical trials are still essential to better understanding treatment efficacy and safety in children affected by AAV. New, validated outcome measures, including those that are patient-reported, will facilitate these much-needed clinical trials in pediatric AAV. SUMMARY There is a continued need for more rigorous study in pediatric AAV, however, there is certainly excitement with the increase in recent research relevant to the pediatric population.
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Affiliation(s)
- Jessica L Bloom
- University of Colorado, Department of Pediatrics, Division of Rheumatology, Denver, Colorado
| | - Eveline Y Wu
- University of North Carolina at Chapel Hill, Department of Pediatrics, Division of Rheumatology
- University of North Carolina at Chapel Hill, Department of Pediatrics, Division of Allergy/Immunology, Chapel Hill, North Carolina, USA
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Tan LW, Wan JL, Zhu CH, Xu H, Xia ZK, Chen LZ, Wu XC, Wang F, Liu XR, Zhao CG, Li XZ, Mao JH, Wang XW, Huang WY, Li YH, Zhang JJ, Feng SP, Yang J, Liu JJ, Gao CL, Rong LP, Shuai LJ, Xu K, Zhang HJ, Li Q, Zhang AH, Wang M. Risk factors for renal outcomes in children with antineutrophil cytoplasmic antibody-associated vasculitis: a nationwide retrospective study in China. World J Pediatr 2024; 20:506-516. [PMID: 37853276 PMCID: PMC11136751 DOI: 10.1007/s12519-023-00753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/31/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Pediatric antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a life-threatening systemic vasculitis featured by liability to renal involvement. However, there are few studies on the risk factors and predictive models for renal outcomes of AAV in children. METHODS Data from 179 AAV children in multiple centers between January 2012 and March 2020 were collected retrospectively. The risk factors and predictive model of end-stage renal disease (ESRD) in AAV were explored. RESULTS Renal involvement was the most typical manifestation (95.5%), and the crescent was the predominant pathological lesion (84.9%). The estimated glomerular filtration rate (eGFR) was evaluated in 114 patients, of whom 59.6% developed ESRD, and the median time to ESRD was 3.20 months. The eGFR [P = 0.006, odds ratio (OR) = 0.955, 95% confidence interval (CI) = 0.924-0.987] and the percentages of global glomerulosclerosis (pGGS; P = 0.018, OR = 1.060, 95% CI = 1.010-1.112) were independent risk factors for ESRD of renal biopsy. Based on the pGGS and eGFR at renal biopsy, we developed three risk grades of ESRD and one predictive model. The Kaplan‒Meier curve indicated that renal outcomes were significantly different in different risk grades (P < 0.001). Compared with serum creatinine at baseline, the predictive model had higher accuracy (0.86 versus 0.58, P < 0.001) and a lower coefficient of variation (0.07 versus 0.92) in external validation. CONCLUSIONS Renal involvement is the most common manifestation of pediatric AAV in China, of which more than half deteriorates into ESRD. The predictive model based on eGFR at renal biopsy and the pGGS may be stable and accurate in speculating the risk of ESRD in AAV children. Supplementary file 2 (MP4 18937 KB).
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Affiliation(s)
- Li-Wen Tan
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Rd.136, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jun-Li Wan
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Rd.136, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chun-Hua Zhu
- Department of Nephrology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, National Paediatric Medical Center of China, Shanghai, China
| | - Zheng-Kun Xia
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Li-Zhi Chen
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Chuan Wu
- Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiao-Rong Liu
- Department of Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
- National Center for Children's Health, Beijing, China
| | - Cheng-Guang Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Zhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
| | - Jian-Hua Mao
- Department of Nephrology, Children Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Wen Wang
- Department of Nephrology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Wen-Yan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Hong Li
- Pediatric Nephrology Department, Guiyang Maternal & Child Health Care Hospital, Guiyang, China
| | - Jian-Jiang Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shi-Pin Feng
- Department of Nephrology, Chengdu Women and Children Central Hospital, Chengdu, 610041, China
| | - Jun Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jiao-Jiao Liu
- Department of Nephrology, Children's Hospital of Fudan University, National Paediatric Medical Center of China, Shanghai, China
| | - Chun-Lin Gao
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Li-Ping Rong
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lan-Jun Shuai
- Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ke Xu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - He-Jia Zhang
- Department of Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
- National Center for Children's Health, Beijing, China
| | - Qiu Li
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Rd.136, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ai-Hua Zhang
- Department of Nephrology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
| | - Mo Wang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Rd.136, Chongqing, 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Singh D, Sukumaran S. Childhood-Onset ANCA- Associated Vasculitis: single center experience from Central California. Pediatr Rheumatol Online J 2023; 21:66. [PMID: 37400890 DOI: 10.1186/s12969-023-00853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Childhood-onset ANCA-associated vasculitides (AAV) are characterized by necrotizing inflammation and include granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Pediatric data is scare and there have been no prior studies examining the characteristics of pediatric AAV in Central California. METHODS This retrospective study comprised AAV patients ≤18 years of age, diagnosed between 2010 and 2021, in Central California. We analyzed initial presentation including demographics, clinical, laboratory characteristics, treatment, and initial outcomes. RESULTS Of 21 patients with AAV, 12 were categorized as MPA and 9 with GPA. Median age at diagnosis was 13.7 years in MPA cohort and 14 years in GPA. MPA cohort were majority females (92% versus 44%). 57% of the cohort were racial/ethnic minority including Hispanics (n = 9), Asians (n = 2), multiracial (n = 1) and 43% were white (n = 9). MPA patients were more frequently Hispanic (67%), meanwhile GPA patients were frequently white (78%). Median duration of symptoms prior to diagnosis was 14 days in MPA cohort and 21 days in GPA cohort. Renal involvement was frequent (100% in MPA and 78% in GPA). GPA cohort had frequent ear, nose and throat (ENT) involvement (89%). All patients were ANCA positive. All Hispanic patients were MPO positive, meanwhile 89% of white patients were PR3 positive. MPA cohort tended towards more severe disease with 67% requiring ICU admission and 50% requiring dialysis. Two deaths were reported in MPA cohort, related to Aspergillus pneumonia and pulmonary hemorrhage. In MPA cohort, 42% received cyclophosphamide in combination with steroids and 42% received rituximab in combination with steroids. GPA patients received cyclophosphamide, either with steroids alone (78%) or in combination with steroids and rituximab (22%). CONCLUSIONS Microscopic polyangiitis was the most frequent AAV subtype with female preponderance, shorter duration of symptoms at onset and higher proportion of racial/ ethnic minority patients. Hispanic children demonstrated frequent MPO positivity. Trends towards higher rates of ICU requirement and need for dialysis upon initial presentation was noted in MPA. Patients with MPA received rituximab more frequently. Future prospective studies are needed to understand differences in presentation and outcomes in childhood onset AAV between diverse racial-ethnic groups.
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Affiliation(s)
- Deepika Singh
- Division of Pediatric Rheumatology, Department of Pediatrics, Valley Children's Healthcare, Madera, CA, USA.
| | - Sukesh Sukumaran
- Division of Pediatric Rheumatology, Department of Pediatrics, Valley Children's Healthcare, Madera, CA, USA
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